Erythema elevatum diutinurum is a relatively rare disease of unknciwr etiology. It is charaterized by persistent erythematous plaque and nodule that are usually affected symmetrically over extensor surface of extremities. Our patient, a 16-year-old female was referred for evaluation of asy nptomatic papules and nodules on extensor aspects of the hands, legs and buttocks. She complained of arthralgia on the knees. The laboratory values were all within normal limits with the exception of slight elevation of white blood cell counts and erythrocyte sedimenation rate. A skin biopsy specimen we obtained from the nodular lesion of the leg that showed preclominantly perivascular neutrophilic influration with occasional lymphocytes and unclear dusts. She was treated with 75mg/day of dapsone. Shin lesions were much improved after ten days. Eight weeks later, the lesion had almost resolved. After the discontinuation of dapsone, new lesions developed on the legs. Retreatment with dapsone resulted it a dramatic response of her lesions after three weeks.
Adolescent ; Arthralgia ; Biopsy ; Buttocks ; Dapsone ; Dust ; Erythema* ; Erythrocytes ; Extremities ; Female ; Hand ; Humans ; Knee ; Leg ; Leukocyte Count ; Lymphocytes ; Neutrophils ; Rare Diseases ; Retreatment ; Skin

Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5th digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic tests such as segmental nerve conduction studies of the ulnar nerve at the wrist were useful for localization of the lesion, and ultrasonography helped to confirm the presence of the lesion. After conservative management, patient symptoms were progressively relieved. Combined electrodiagnostic studies and ultrasonography may be helpful for diagnosing and detecting ulnar neuropathies of the wrist following carpal tunnel release surgery.
Carpal Tunnel Syndrome ; Elbow ; Female ; Hand ; Humans ; Median Neuropathy ; Middle Aged ; Neural Conduction ; Sensation ; Ulnar Nerve ; Ulnar Neuropathies ; Wrist

BACKGROUND: We have already shown that a new vitamin D3 analogue, calcipotriol is a potent growth inhibitor for human keratinocytes, indicating the close relationship between the in vitro inhibitory effect of calciipotriol and its therapeutic effectiveness or psoriasis. OBJECTIVE: Our purpose was to evaluste the clinical efficscy, safety and tolerability of calcipotriol (50ug/g) ointment twice daily in the treatment of psoriasis. MEHTODS: We treated 31 patients with calcipotriol for 6 weeks. Patients were provided with a maximum of 100g of ointment per week. Efficacy, as measured by the Psoriasis Area and Severity Index(PASI), and safety were assessed at 2,4, and 6 weeks. RESULTS: Reduction of PASI was stastistically significant at all time points for treatments (p<0.01). At the completian of 6 weeks of treatment, the mean PASI reduction was 3.61. An analysis of patient overall self-assessment, at 6 weeks showed clearance or marked improvement in 61%. Some patients developed minimal irriltation of lesional or perilesional skin(6.5%). Laboratory tests did not show any significant changes, in particular there was no change in serum calcium levels. CONCLUSIONS: Calcipotriol ointment was effective as measured by the PASI and the self-assessment in patients with psoriaeis. This treatrnent was well tolerated.
Calcium ; Cholecalciferol ; Humans ; Keratinocytes ; Psoriasis* ; Self-Assessment

OBJECTIVE: To compare a newly developed minimally-invasive method for percutaneous transforaminal epidural injection (INJ group) with the existing method for lumbar epidural catheterization (CATH group). METHOD: Through anatomical review of experimental rats, the cephalic one fourth of the neural foramen was selected as the target point for drug delivery. After the rats had undergone lumbar epidural catheterization, lidocaine, and 1% methylene blue were injected through the unilateral or bilateral L5/6 neural foramen in the INJ group, and through an epidural catheter in the CATH group. Measurement of body weight and the mechanical allodynia test before and after injection of lidocaine, and fine dissection after injection were performed. RESULTS: Results of the mechanical allodynia test of 1.0% lidocaine 50 microl injection in the CATH group were statistically similar to those of 0.5% lidocaine 100 microl injection in the INJ group. The results of 2.0% lidocaine 50 microl injection in the CATH group were statistically similar to those of 1.0% lidocaine 100 microl injection in the INJ group. After dissection, only one distal partial spinal nerve was stained by methylene blue 50 microl through the transforaminal pathway. However, the dorsal root ganglion, nerve root, and adjacent hemi-partial spinal cord were stained by methylene blue 100 microl through the transforaminal pathway. CONCLUSION: The percutaneous transforaminal epidural injection is practical, easy, and safe, and, in particular, does not cause significant pain compared to the existing lumbar epidural catheterization. We expect this method to be effective in an animal study showing that drug delivery to the spinal epidural space is necessary.
Animals ; Body Weight ; Catheterization ; Catheters ; Epidural Space ; Ganglia, Spinal ; Hyperalgesia ; Injections, Epidural ; Lidocaine ; Methylene Blue ; Rats ; Spinal Cord ; Spinal Nerves

OBJECTIVE: To analyze the relationship between painful hemiplegic shoulder (PHS) and ultrasonographic (US) findings according to the motor recovery stage of the stroke. METHOD: The medical records were reviewed retrospectively in 82 stroke patients from January 2005 to November 2009 who undertook US examination on hemiplegic shoulder. The clinical data collected were age, gender, stroke type, affected side, duration from stroke onset, manual function test (MFT) and the Brunnstrom stage of arm. The presence of spasticity, glenohumeral subluxation and sensory impairment were also investigated. The patients were classified into three groups according to the Brunnstrom recovery stage: the first, second and third recovery stages (RS1, RS2 and RS3). Furthermore, the correlations between US findings and the clinical characteristics according to the Brunnstrom recovery stage were analyzed. RESULTS: The presence of spasticity, glenohumeral subluxation, sensory impairment (proprioception) and MFT scores had statistically significant differences in each group. Among the 82 stroke patients, 62 patients (75.6%) had abnormal findings in US examination. The common abnormal structures were supraspinatus tendon (SST), biceps long head tendon (BLH), subacromial-subdeltoid bursa (SA-SD bursa). The frequencies of total US abnormality in each group were not significantly different (p=0.07). However, the SST abnormality was more frequent in the RS1, and the BLH and SA-SD bursa abnormality were more frequent in the RS3 (p<0.05). CONCLUSION: In this study, abnormal findings in US examination are frequent in PHS. The abnormal SST is related to the flaccidity, and the abnormal BLH and SA-SD bursa are related to the overuse.
Arm ; Head ; Humans ; Hydrogen-Ion Concentration ; Medical Records ; Muscle Spasticity ; Retrospective Studies ; Shoulder ; Shoulder Dislocation ; Stroke ; Tendons

We aimed to determine the recommendation level for the treatment of acute and chronic low back pain (LBP). A systematic review (SR) of the literature was performed and all English-language articles that discuss acute and chronic LBP, including MEDLINE and the Cochrane Database of Systematic Reviews, were searched. Of the 873 searched literature reports, 259 articles, including 131 clinical trials, 115 SRs, nine meta-analyses, and four clinical guidelines were analyzed. In these articles, high-quality randomized controlled trials, SRs, and used well-written clinical guidelines were reviewed. The results indicated multiple acute and chronic LBP treatment methods in the literature, and these reports when reviewed included general behavior, pharmacological therapy, psychological therapy, specific exercise, active rehabilitation and educational interventions, manual therapy, physical modalities, and invasive procedures. The Trial conclusions and SRs were classified into four categories of A, B, C, and D. If there were not enough high-quality articles, it was designated as “I” (insufficient). This review and summary of guidelines may be beneficial for physicians to better understand and make recommendations in primary care.

OBJECTIVE: To evaluate the clinical efficacy and safety following percutaneous disc decompression, using navigable disc decompression device for cervical herniated nucleus pulposus (HNP). METHODS: Twenty subjects diagnosed with cervical HNP and refractory to conservative management were enrolled for the study. The herniated discs were decompressed under fluoroscopic guidance, using radiofrequency ablation device with navigable wand. The sagittal and axial plain magnetic resonance images of the clinically significant herniated disc, decided the space between the herniated base and outline as the target area for ablation. Clinical outcome was determined by Numeric Rating Scale (NRS), Neck Disability Index (NDI), and Bodily Pain scale of Short Form-36 (SF-36 BP), assessed after 48 weeks. After the procedure, we structurally matched the magnetic resonance imaging (MRI) and C-arm images through bony markers. The wand position was defined as being ‘correct’ if the tip was placed within the target area of both AP and lateral views; if not, the position was stated as ‘incorrect’. RESULTS: The average NRS fell from 7 to 1 at 48 weeks post procedure (p<0.05). In addition, statistically significant improvement was noted in the NDI and SF-36BP (p<0.05). The location of the wand tip resulted in 16 correct and 4 incorrect placements. Post-48 weeks, 3 of the incorrect tip cases and 1 correct tip case showed unsuccessful outcomes. CONCLUSION: The study demonstrated the promising results and safety of the procedure. Thus, focal plasma ablation of cervical HNP with navigable wand can be another effective treatment option.
Catheter Ablation ; Decompression* ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Neck ; Neck Pain ; Plasma ; Treatment Outcome*

Recurrent macrophage activation syndrome (MAS) is very rare. We present the case of an adolescent boy with human leukocyte antigen (HLA) B27-positive ankylosing spondylitis (AS), who experienced episodes of recurrent MAS since he was a toddler. A 16-year-old boy was admitted because of remittent fever with pancytopenia and splenomegaly after surgical intervention for an intractable perianal abscess. He had been diagnosed with hemophagocytic lymphohistiocytosis (HLH) 4 different times, which was well controlled with intravenous immunoglobulin and steroids since the age of 3. We were unable to identify the cause for the HLH. He remained symptom-free until the development of back pain and right ankle joint pain with swelling at 15 years of age. He was diagnosed with HLA B27-positive AS with bilateral active sacroiliitis. He showed symptom aggravation despite taking naproxen and methotrexate, and the symptoms improved with etanercept. On admission, his laboratory data showed leukopenia with high ferritin and triglyceride levels. Bone marrow biopsy examination showed histiocytic hyperplasia with hemophagocytosis. There was no evidence of infection. He received naproxen alone, and his symptoms and laboratory data improved without any other immunomodulatory medications. Genetic study revealed no primary HLH or inflammasome abnormalities. In this case, underlying autoimmune disease should have been considered as the cause of recurrent MAS in the young patient once primary HLH was excluded.
Abscess ; Adolescent* ; Ankle Joint ; Autoimmune Diseases ; Back Pain ; Biopsy ; Bone Marrow ; Etanercept ; Ferritins ; HLA-B27 Antigen ; Humans ; Hyperplasia ; Immunoglobulins ; Inflammasomes ; Leukocytes ; Leukopenia ; Lymphohistiocytosis, Hemophagocytic ; Macrophage Activation Syndrome* ; Macrophage Activation* ; Macrophages* ; Malaria ; Male* ; Methotrexate ; Naproxen ; Pancytopenia ; Sacroiliitis ; Splenomegaly ; Spondylitis, Ankylosing* ; Steroids ; Triglycerides

OBJECTIVE: To determine whether electrophysiologic findings of ulnar neuropathy at the elbow (UNE) are associated with anatomic location or a pathophysiologic mechanism, electrophysiologic findings of ulnar neuropathy above the elbow (UNAE) and below the elbow (UNBE) were compared. METHOD: Electrophysiologic findings of 56 patients with UNE were analyzed: segmental ulnar motor conduction study with abductor digiti quinti (ADQ) and first dorsal interosseous (FDI) recordings, ulnar and dorsal ulnar cutaneous nerve (DUCN) sensory action potentials, and needle electromyographic findings. Based on anatomic location, lesions were divided into UNAE and UNBE. Based on pathophysiologic findings, they were classified into three groups (focal demyelination, axonal degeneration, and mixed lesion). RESULTS: Twenty-eight patients were diagnosed with UNAE, and 28 with UNBE. Of the patients with UNAE, 4 had focal demyelination, 2 showed axonal degeneration, and 22 were of mixed lesions. Of patients with UNBE, 5 had focal demyelination, 6 showed axonal degeneration, and 17 were of mixed lesions. No significant differences in pathophysiologic mechanisms, or in electrophysiologic findings, were observed between UNAE and UNBE. The proportion of positive findings of focal demyelination was higher in FDI recording than in ADQ recording; however, this finding was not statistically significant (p>0.05). Thirty of 31 patients with abnormal DUCN had axonal degeneration with or without focal demyelination, whereas 9 of 25 patients with normal DUCN had focal demyelination only (p<0.05). CONCLUSION: Electrophysiologic findings did not relate to the anatomic location of UNE, but could relate to the pathophysiologic severity or fascicular involvement of the lesion.
Action Potentials ; Axons ; Demyelinating Diseases ; Elbow ; Humans ; Needles ; Polymethacrylic Acids ; Ulnar Neuropathies ; United Nations

PURPOSE: L-asparaginase is a crucial chemotherapeutic agent for the treatment of acute lymphoblastic leukemia. However, hypersensitivity to L-asparaginase is common which limits its clinical use. METHODS: We performed 44 cases of premedication and 3 cases of desensitization in 16 patients with hypersensitivity to L-asparaginase. RESULTS: With premedication, 33 cases completed L-asparaginase injection with no hypersensitivity reactions. Eleven cases showed mild hypersensitivity reactions, such as urticaria. Desensitization was performed in 3 cases: in 2 cases, desensitization was successful, and in 1 case the medication was switched to Erwinia asparaginase. CONCLUSION: Premedication and desensitization appear to be useful in helping patients receive desired doses of L-asparaginase in pediatric patients with acute lymphoblastic leukemia.
Asparaginase ; Desensitization, Immunologic ; Drug Hypersensitivity ; Erwinia ; Humans ; Hypersensitivity* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Premedication* ; Urticaria